Temporomandibular Joint Dysfunction (TMD)

The temporomandibular joint (TMJ) is the joint that connects your jaw bone to your skull and is located directly in front of your ear. Pain in this region can be the result of postural deficits, stress, bad habits, and acute injury to the jaw. Symptoms are often recognized as pain with chewing, jaw stiffness/locking, and painful popping or clicking when opening/closing the jaw. In most cases, TMD resolves quickly and independently, but in other cases additional guidance is required to reduce pain and improve jaw function.

Helpful Hints to Relieve Jaw Pain:

  1. Correct posture especially in unsupported seated positions.
  2. Reduce stress levels.
  3. Place your jaw in its resting position (Say “Emma” – this word in particular puts the jaw in a completely rested position.)
  4. Use a warm compress on the joint to relax jaw muscles.
  5. Limit bad habits – reduce clenching of the teeth, avoid biting your nails, and limit gum chewing.
  6. Avoid overuse of the jaw – reduce intake of chewy foods, limit yelling and yawning.

If you continue to have pain, physical therapy helps to relieve discomfort by improving jaw alignment through manual work, modalities, and exercise.

It’s a Bird. It’s a Dog. It’s a Bird Dog!

The bird dog is a simple exercise that enhances core strength, provides stability, aids in neutralizing spine position, and reduces the onset of low back pain. 

The bird dog:

  1. Improves spinal and core stability by stiffening the musculature and enhancing muscular endurance.
  2. Improves hip extension by increasing glute strength and aids in differentiating low back extension and hip extension. 
  3. Improves shoulder stability by loading the joint with your body weight to help maintain stability throughout the exercise.
  4. Improves balance and coordination by engaging in contralateral muscle movements while maintaining proper positioning.

If this exercise is too difficult to perform with contralateral movements – try performing one limb at a time until your balance and stability improves – progress as tolerated!

Focus on Strength Training as You Age

Photo from Harvard Health

Aging is inevitable; losing your strength and ability to perform daily activities doesn’t have to be. Sarcopenia is a term used to describe the age-related progressive loss of muscle mass and strength. The process begins in your 40s and ramps-up between the ages of 65 and 80. While age-related strength loss is normal, sarcopenia speeds up the loss of muscle mass and can reduce your muscle mass by 8% each decade. Factors such as insulin resistance, obesity, loss of mobility, and inactivity contribute to the progressive loss of muscle mass in older adults and as a result increase the risk for falls and make daily activities difficult to perform. 

Sarcopenia is often diagnosed with the following mnemonic:

S – strength (loss of strength)

A – assistive device (use of a device for walking)

R – rising from a chair (difficulty standing from a chair without use of hands)

C – climbing stairs (difficulty with stair climbing)

F – falls (presence of falls in the last year)

Aging might suddenly sound daunting, but it doesn’t have to be as long as you stay moving! Improving your strength and staying active reduces your risk at developing sarcopenia and also improves your quality of life. Strength training alone can improve your ability to complete daily activities, protect your joints from injuries, improve your balance, and reduce your risk for falls. It can also enhance your thinking skills, improve bone density (to reduce risk for osteoporosis), and help manage chronic conditions such as diabetes, heart disease, and depression. 

Strength training as you age doesn’t have to be difficult. Research shows that exercising even just 2-3x per week can enhance muscle mass and strength. Ideally, 2-3 sets of 1-2 exercises for each major muscle group should be performed. If the “ideal” situation doesn’t exactly match your lifestyle, try starting small and just get moving! Any physical activity is better than no physical activity, because even small steps lead to big changes. Try walking more often, getting up out of your chair repetitively to build leg strength, lifting small weights, or joining a fitness class at your local facility; make the change to live a longer healthier life! 

Written by- Dr. Emilee Strange, staff PT at Harbor PT

Benefits of Squatting

Squatting isn’t just for those really muscular people who put 700lbs on their back at the gym. In fact, I bet you don’t even realize how often you squat in a day. Think about the number of times you sit down on a chair and have to get back up, the number of times you go to the bathroom in a day, or even the amount of time you spend bending down to pick something up you might have dropped… This is constant, every-day squatting!

The squat is one of the most important exercises to perform for a wide variety of reasons. The squat aids in (1) increased leg strength, (2) increased core strength and lumbar stability, (3) increased hip and ankle mobility, (4) helps aid in the reduction of injury, and (5) increased metabolic rate due to muscle growth. Muscle loading the squat can be an effective way to increase muscle growth in the quadriceps, glutes, and hamstrings. Additionally, increased repetitions of squats with minimal muscle loading can enhance muscle endurance; this improves your ability to perform daily activities, increases athletic performance, and helps maintain improved posture/stability for extended periods of time. 

Should I squat below 90?

Squatting below parallel does not increase your risk for knee injuries, however, it does often increase your risk for breaking proper squat form/mechanics. Squatting below parallel does not provide any significant muscle activation benefits, but can enhance mobility. Studies show minimal differences between squatting to 90 and squatting below 90. Most importantly, maintain good form and mechanics before progressing the depth of your squat – this will enhance overall benefits.

Written by: Dr. Emilee Strange, staff physical therapists at HPT

photo credit- santacruzcore.com

The Power of a Corset

In the early centuries, a corset was typically worn as a supportive undergarment that improved posture, supported the spine, and shaped the body into what was then called “ideal proportions.” While corsets used to come in many shapes, sizes, and colors – in today’s world the most important “corset” goes by a single name – the Transverse Abdominis (TrA). 

The TrA is the deepest of the abdominal muscles and acts a girdle around the spine. The TrA responds most to perturbational movement and is the only abdominal muscle that remains activated with resisted extension in the spine (resisted extension often comes with exercises such as lifting a box incorrectly, deadlifts, and a quick jerking motion backwards). The TrA is the first stabilizer that kicks in with any arm/leg movements, and as a result helps limit your risk for injuries. It also aids in stabilizing each bone in your spine; so without this muscle, your spine would just be dancing around, pinching on nerves, and collapsing (almost). 

The take home here is… the TrA is very important! You need this muscle to assist in stabilizing the spine and when it doesn’t do its job… you end up with back pain. The TrA is difficult to control. It doesn’t work like the 6-pack abs you’re used to. Try activating your TrA to reduce your risk of low back pain, improve your core and back stabilization, and reduce your risk for injury.

Transversus Abdominis- photo credit- physiopedia.com

Written by Dr. Emilee Strange, staff PT

When do I need an MRI?

If you are experiencing an ache or pain that is persistent, you want to see a medical professional to determine your treatment plan. In the state of Maryland, you can see a physical therapist without seeing a physician first. If you choose to do this, a physical therapist will perform an evaluation to determine your plan of care. If a physical therapist feels seeing a physician is necessary based on your evaluation, it will be recommended. This is the same for an MRI. If you see a physical therapist first, we are unable to prescribe imaging but we will recommend you see a physician to ultimately get imaging. Most people go through a round of conservative treatment, such as physical therapy prior to receiving an MRI. An MRI is recommended when physical therapy is not improving symptoms or you are hitting a plateau with improvement. Most insurance companies will not approve paying for an MRI without the patient having physical therapy first. If you are unsure of what you need to do for the next step in your treatment plan, make sure to make an appointment with a physician or physical therapists to help guide you.

Why Does my Back Hurt?

Many patients come to physical therapy with back pain. They come in asking the question, “why does my back hurt?” Well, the answer is not the same for everyone. A physical therapist has to perform a thorough evaluation to determine the cause of the patient’s back pain. The evaluation consists of finding out specific details from the patient about their back pain. This leads the therapist into a specific evaluation of the patient’s range of motion, strength, flexibility, and stability. Typically back pain comes from a lack of mobility, strength, and flexibility. For some patients, it is more of a decrease in flexibility, for others because of strength deficits, and some folks it is a combination of both. Once this is determined, your therapist will develop a plan of care to improve upon the deficits found during your evaluation. On average, it takes 4-6 weeks of consistent physical therapy to achieve the ultimate goal of decreased pain and improved function. The key as a patient is to be patient and stick with the plan. If after a month of physical therapy you do not notice any improvements, make sure to speak with your physical therapist to determine the appropriate continued treatment plan.

Ergonomic Tips for Working from Home

If you find yourself working from home more than you normally would, you should consider these tips to avoid an onset of neck, back, or wrist pain.

  1. Choose the correct workspace – Avoid sitting on a sofa or bed while getting your work done. Instead, you should find a chair that has good low back support and a table or desk that you can place your laptop on.
  2. Maintain correct posture
  3. Try to sit with your feet flat on the floor instead of letting them dangle.
  4. Place your laptop so that the top of the screen is at eye level to avoid straining your neck.
  5. Try to avoid slouching over the computer by keeping your shoulders pinched back as you work or using your chair’s back support.
  6. Your forearms should be able to rest lightly on your armrests and desk and your wrists should stay in a neutral position.
  7. Take frequent breaks – Stand up and walk around for a few minutes at least once an hour at a minimum. If you can avoid staying in one position for too long, it can help to decrease any stiffness you may feel throughout the day.
photo credit- medicalnewstoday.com

How to Make Exercising Fun!

We all know that regular physical activity is an important part of staying healthy, but committing to a regular exercise routine isn’t always easy to do- in fact, sometimes it can seem quite daunting. But it doesn’t have to be! You are more likely to stick to an exercise routine if you enjoy what you are doing and if it is easily accessible/attainable. Check out and explore your options and find something that works for you so exercise becomes part of your everyday life! Below are some ideas on how to make exercise more enjoyable:

  • Make a game out of it
    • Deck of Cards – in this game you turn a 52 card deck into a workout. Take out the Jokers and come up with one exercise for each suit and then shuffle the deck and place it face down. Pick up one card at a time and perform the exercise for that suit for the amount of repetitions designated by the number on the card (*all face cards equal 10 repetitions)
      • Variations can include making the 4 exercises all lower body focused, upper body focused, core focused, etc.  
      • Progressions can involve timing yourself and trying to “beat the clock” the next time you perform that set of exercises. Or you can choose more complex exercises to perform. 
    • Exercise Roulette – for this game, you write down various exercises on individual pieces of paper, fold them in half and toss them in a box/hat/bowl/etc. Once you decide how many exercises to do, you choose that many from the box and to create your workout. Then, you choose how many sets and the duration. A sample workout could be to pick 5 exercises and perform each for 50 seconds with a 10 second rest between each and then repeat that circuit 3 times. 
      • Variations can be similar to those listed in the Deck of Cards explanation.
      • Progressions can involve increasing your “on” time, decreasing your “off” time, or just choosing more exercises to complete.
  • Find a class 
    • In Person – Gyms, fitness centers, and sporting goods stores everywhere provide a wide variety of classes for people of all ages and fitness levels. If you belong to a gym, explore the classes they offer and see if one is a good fit for you. If you don’t belong to a gym, do your research to see what is available in your area (and keep an eye out for programs that may offer a free first lesson or a certain amount of classes at a discount). 
    • Virtual – Since the pandemic, virtual workout classes have been on the rise. You can find practically any kind of exercise/workout class online now and some fitness centers/gyms even have virtual access to lessons. Take some time and browse the web for what might interest you, and be sure to look at all different channels/accounts to see what instructor(s) work best for you. 
  • Meet with a friend/group
    • If you don’t feel comfortable going to a group class for whatever reasons, try meeting up with a friend or two to exercise. This will help pass the time and keep you accountable.

Written by: Dr. Taylor Ryan

Why Should I Strengthen my Core?

Your core muscles are important for strength, balance, and overall function. Having a strong core helps to decrease the likelihood of developing back pain due to muscle compensation. There are many core exercises that can be performed in a variety of positions. You can even contract your core while performing any exercise of your choice to make the exercise into a core strengthening exercises.

Here is a core strengthening exercise you can perform anywhere to strengthen your core muscles.

  1. Assume a push-up position but bend your arms at your elbows so your weight rests on your forearms.
  2. Tighten your abs, clench your glutes and keep your body straight from head to heels.
  3. Start by holding the exercise for 10 seconds and build from there.

Make sure you are breathing while performing this exercise.